Ulnar palsy

Function of the first dorsal interosseous muscle is lost after ulnar nerve injury and the subsequent
wasting gives the hand a skeletal appearance. The interossei have altogether a large cross
sectional area and the combined muscle mass can exert a considerable force although the
excursion is less than the extrinsic tendons. Nevertheless the loss of interossei results in a
marked reduction of grip strength.

High ulnar palsy or cubital tunnel syndrome: At the elbow the ulnar nerve is prone to injury
behind the medial epicondyle. The consequences of such injury include those described for
lesions at the wrist. Additionally, the medial half of flexor digitorum profundus and flexor carpi
ulnaris are paralyzed or weakened and the dorsal and palmar cutaneous branches are affected.
A similar pattern of functional deficit occurs if the nerve becomes entrapped as it passes through
the tendinous arch of origin of flexor carpi ulnaris (cubital tunnel syndrome).

Ulnar palsy (Guyon’s canal at the wrist): A lesion of the ulnar nerve at the wrist or compression
within Guyon’s canal results in weakness of all the intrinsic muscles to the fingers except the
lumbricals of the index and long fingers. It also includes the adductor pollicis and the deep head
of the flexor pollicis brevis.

The interossei and lumbricals normally flex the metacarpophalangeal joints and extend the
interphalangeal joints through their attachments to the extensor apparatus. The classic deformity
in ulnar palsy is clawing of the ring and little fingers due to paralysis of these muscles.
Paradoxically, lesions of the ulnar nerve before the motor branch to the flexor digitorum profundus
causes less clawing because of absence of tension in the profundus muscles.

Froment's sign in the thumb is sometimes present in ulnar palsy. It occurs during pinching when
the adductor is unable to provide its stabilizing support to the thumb MP and IP joints. The flexor
pollicis longus hyperflexes the IP joint to substitute for the loss of the stabilizing adductor.

Sensation is impaired over the palmar aspect of little finger and medial half of the ring finger.
Since palmar and dorsal branches of the nerve arise proximal to Guyon's canal, sensibility in the
ulnar aspect of the palm and dorsally over the hand is preserved.

The first dorsal interosseous is a useful muscle to test in assessing recovery from ulnar nerve
injury as it is one of the most distal muscles in the hand to be innervated by the deep branch of
the ulnar nerve.

Clinical testing for the function of the first dorsal interosseous muscle is by asking the patient to
‘‘keep the index finger and thumb straight, and bring them together.’’ The contracting muscle can
be palpated in the web space between these digits and compared with the other side (Semple’s
test).